If you’ve been struck with a severe medical illness, then PTSD is like the mental aftershock. Instead of recovering from your initial illness, you can end up struck with panic attacks that turn recovery into a sequel to your suffering. Just because you can’t recover feelings of calm equanimity, however, doesn’t mean that you’re not on the mend or that you can’t lead a meaningful life in spite of anxiety and not working. Learn how to fight negative thinking, even when life sucks, the anxiety won’t go away, and the ground never stops shaking, and you can still find meaningful things to do with each day.

-Dr. Lastname

My life is currently in complete disarray and I’m on medical leave from work to resolve my health issues, which almost took my life several times over the last few years. I go to a therapist who also teaches yoga, and started seeing a CBT as well, but my daily life is still miserable and I need help. I’m currently sitting at my computer sweating, crying, shaking and no amount of medicine or breathing technique or exercise is helping. My goal is to figure out how to get my health issues under control.

Expecting to get most health issues under control, including depression and panic attacks, is often a way to make yourself even more unhappy and sick.

That’s because we can never totally control our health or our illnesses, and cures are few and far between. In your case, you’re obviously doing all the right things—getting medical help, seeing therapists, exploring various kinds of treatment—so give yourself credit for what you’re doing, and cut yourself some slack for not being able to control what your brain and body have decided to do on their own.

It’s hard not to feel overwhelmed when you’ve recently experienced extreme medical problems, and it’s impossible not to get freaked out when experiencing the extreme symptoms of a panic attack, but you know, deep down, that the anxiety will pass.

When you have a specific goal for yourself or someone you care about, it’s useful to imagine that goal as a physical destination, and set limits as the directions for getting there. After all, just nagging someone to do something they wouldn’t instinctively do is like being a GPS that tells the driver to “just get there,” and worrying about making a goal you haven’t considered carefully will leave you driving in circles. If you want to determine those limits, you need to know why your limits are better than the alternative so you can fully explain them, even if it’s just to yourself. If you can properly weigh the value of limits in terms of improvement, then you or that someone you care about can arrive at your goal via the best route possible.
–Dr. Lastname

I can’t stand watching my son come home from school everyday, earphone in one ear, and go straight upstairs without acknowledging anyone so he can go hole up in his room and text and play videogames. When I tell him to get his face up and out of a screen before I take every last device away, he asks me why I’m punishing him. He’s a good kid and gets his schoolwork done eventually, but he doesn’t help out around the house or really engage on any level. My goal is to get him to see that it’s not healthy to do nothing but mess around with all this vapid technology without having to fight with him all the time.

It would be nice to have the kind of kid who naturally likes to socialize, chip in, and keep busy with healthy activities, but humans like that at any age are rare. After a long day—and, if he’s in high school, lord knows what horrors his day can include—most of us just want to zone out and relax with a glass of wine/Xbox.

Human beings have figured out how to get to space, train a dog to recognize letters, and make a sandwich where the bread is actually chicken, but we’re still generally at a loss when confronted with the offer of help. It shouldn’t be that confusing, but accepting help can be necessary while feeling humiliating, or it can be humiliating while feeling necessary, and either way, the answer is remarkably unclear. Once you know what you need the help for and whether it’s necessary for your personal goals, however, then you’ll know whether it’s good for you, regardless of how it feels or looks to anyone else. It might never be easy to accept or refuse help (or eat meat on two pieces of poultry), but it’s easy to figure out whether accepting is the right thing to do.
–Dr. Lastname

I know I’ve been a total fuck-up for the last few years, and my family thinks I’ve blown through all my savings and gone into debt besides, but the truth is worse than they think. And because I know it’s all my fault, I get really depressed and angry at myself, which makes it impossible to get the courage and energy to try to get back on track. I’m too afraid and ashamed to talk to anyone, so my friends and work contacts have pretty much disappeared. Insanely, my parents and brothers still care enough to offer to help me get back on my feet, but I know they’re just offering out of pity, and I won’t be able to live with myself when I lose their money and let them down. My goal is to rescue myself without my family having to pick me up.

You might have thought your mom, little league coach, and/or high school girlfriend were full of shit when they tried to console you for a poor result, but they were right when they said that a good effort is more valuable than a great deal of success. Equating success with winning would explain why you feel like such a loser right now.

The higher your standards and/or self-opinion, the deeper the rut when your winning streak ends and the steeper the metaphorical climb back to an acceptable normal. That’s why, at a time you most need energy, focus, and social skills, shame for being less-than-excellent keeps you trapped in an emotional crevasse.

The only antidote to feeling like you’re insanely ungreat is to remember that life is hard, luck is important, and you’re always doing right if you’re ready to work and trying to be independent. Basically, you can’t hold yourself responsible for success or failure, just for the effort you make to achieve the former and avoid the latter. WAIT! There is more to read… read on »

We’ve written many times about the way mental health professionals especially tend to be either demonized or canonized; nobody expects their dentist to fix their lives or thinks their accountant is a monster and a fraud when s/he’s not perfect, but these are the expectations for those who deal in problems that are frightening and poorly understood, like mental illness. People would like to think therapists can provide control, but they’d also like to think the problem will go away by itself if you return to your usual routine. If you can accept the fact that some problems can’t be solved, however, and that the influence of professionals is always limited, you’ll be ready to learn everything you need to know and become your own expert on tough problems, imperfect professionals, and, if you’ve got the time, your own taxes.
–Dr. Lastname

My fifteen-year-old son does poorly in school whenever he gets depressed, which is fairly often, but his current school’s counseling staff is totally worthless—they haven’t just failed to help him, but so many students that their ineptitude is an open secret amongst parents and teachers—so I’m worried that they won’t do much for him once the depression starts and his grades slip. My goal is to figure out what to do to get his school to provide the counseling services he (and other kids) deserve.

If counseling were a reliably good treatment for depression and was available exclusively through schools, then you’d have a worthwhile fight on your hands. The movie version would win awards and you’d get your face on a dollar coin.

Unfortunately for your Oscar dreams, but fortunately for your son, the stakes for your battle aren’t nearly that high.

In reality, the help that almost all counseling provides is limited, and may have less to offer now that you and your son are knowledgeable about depression and can talk to one another about it. Your school’s counseling staff may be especially weak, but their legendary ineptitude need not get in your son’s way. WAIT! There is more to read… read on »

As with nuclear waste, old hard drives and used take-out containers, there’s no clear way to dispose of unpleasant thoughts; some people feel like nasty feelings should be buried and ignored, and others that they must be purged and shared in order to be expunged. In actuality, feelings often aren’t unworthy even when they make you feel vaguely guilty, and don’t need airing even when they whine at the door and ask to be released. Before you decide whether your thoughts are hazmat grade, weigh them against your values and the consequences of self-expression. Often, you’ll find they don’t need to purged, just safely ignored.
–Dr. Lastname

After 25 years of happy marriage and three great kids together, I lost my wife to cancer two years ago. I think I’m ready to find another partner at this point, but I felt weird the other day when a co-worker suggested he set me up with a friend and I said I wasn’t ready. The truth is, I know a bit about her and, though she’s a nice person, she’s been struggling to find fulltime work for a few years now and there’s no way I could afford my current lifestyle if I had to support a partner. My goal is to figure out whether there’s something wrong with putting money ahead of love.

Having raised three kids and nursed a wife through cancer, you know that money isn’t the enemy of love— life is.

Life throws trouble at you, like medical problems and tuition, and love is what helps you give things their proper priority and makes you hurt when you can’t do as much as you’d like.

If you had no one to love in your life, and no better opportunity to find someone to share it with, then you might have good reason to sacrifice wealth and stability for a loving partnership. WAIT! There is more to read… read on »

In this day and age, it’s almost impossible not to know what Attention Deficit Disorder is (or to not have a direct connection to someone who has it, or to not have an opinion on it, just because). On the other hand, very few people are aware of Attention Surfeit Disorder, which is when people habitually get so perfectly focused on the problems that grab them that they can’t see why anything else matters, even if it’s a looming disaster. Whether you can’t focus on any one thing or focus far too much on one thing exactly, be aware that our brains have different ways of focusing, and that each has its own strength and weakness. Then, whether you have a fun diagnosis or not, you’ll be better at managing your priorities instead of following whatever captures your attention.
–Dr. Lastname

I’m curious to your thoughts on subclinical anorexia. I was (voluntarily) hospitalized with anorexia nervosa last year. Since then I’ve managed to keep my weight out of the danger zone, but not up to where my physicians would like it. Honestly, I don’t see the point. Even at my lowest weight I completed an MPH at Hopkins (my third post-graduate degree), I’m in the “healthy” BMI range, technically, and I hold a full time job in addition to teaching science at a local University two nights a week. Who the hell cares if I don’t hit my target weight? My goal is to continue to achieve excellence without worrying too much about what doctors tell me about my weight.

When you focus too much on perfection in one particular aspect of your life, be it in terms of appearance or professional achievement, it’s like searching for a house based on the quality of the faucets; you become so fixated on the gleaming chrome that you don’t notice the lack of square footage, light, or even plumbing.

Obsessional, single-minded focus is always unhealthy when it gets you to disregard whatever else is truly important in your life, like your health and friendships. You tell yourself it’s good to work harder to make yourself better…while losing track of the fact that what you’re sacrificing is worth more than the excellence you’re driven to achieve. WAIT! There is more to read… read on »

Despite what the Ramones (R.I.P.) once declared, most people do not want to be sedated, especially if it’s for reasons involving “going loco.” Some people can’t think about psychiatric hospital admission as other than a form of kidnapping, and others as a failure that should never have happened if they took proper care of themselves. In reality, it’s good to think about psychiatric admission as something that can happen again regardless of how well you take care of yourself, and will rarely happen for reasons that you won’t ultimately agree with. The more you accept the possibility of hospital commitment and consider your own views about what makes hospitalization necessary, the more skilled you’ll be at managing the situation if it occurs again, even if it’s something you’re never going to wanna do.
–Dr. Lastname

I’ve got depression that is usually controlled well by medication, but I had one bad episode three years ago when I got really down, couldn’t leave the house for a month, and was on track to starve myself to death. My parents were right to pull me out and take me to the hospital, but it was a horrible experience; there were some scary, sick people there, and staying there was traumatizing. Now my shrink wants me to put together a crisis plan that will tell my parents how to decide when they should take me to the hospital, if it ever becomes necessary again—a sort of “advance directive”—and I’m trying to figure out how to make sure that I don’t have to go back unless it’s really, really necessary. The last thing I want is to visit an emergency room where they like to lock people up, so I end up trapped in the nightmare ward again. My goal is to figure out how to minimize the possibility that I will get admitted again.

As traumatic as it felt to be admitted to a psychiatric hospital, you are familiar with the bigger trauma that you would have experienced if you weren’t admitted. The scary people you say in the psych ward were probably fairies and pussycats compared to the hellscape that your own home had become.

You know how painful your depression was, how it interrupted everything important in your life, including work, relationships and your ability to care for yourself, and how it endangered your health and your life. That’s the trauma it’s now your job to manage, and avoiding the job because you’d like to avoid the hospital is a foolish move. WAIT! There is more to read… read on »

While most people with mood disorders don’t technically “hear voices,” they sometimes experience something much scarier; their own internal monologue lying to them. Whether your mental illness is convincing you you’re worthless or the king of the world, don’t follow your corrupted instincts when it comes to managing medications and drawing up safety plans. Instead, study the facts, learn from your own experience, and plan the odds, rather than letting your confidence play you and make you crazier than you really are.
–Dr. Lastname

I am a doctoral candidate preparing to defend and graduate in May. I am so terrified of what comes next (giant black hole; there be dragons) that I am undermining my progress and succumbing to despair. This is tied to my utter lack of ambition. I don’t know how to dream Real Things. All this worry and fear and lethargy leaves me feeling exhausted. And I am so worried and so frustrated with (what I perceive to be) my laziness, my incompetency that I become angry at the smallest things. How can I learn to get work done and to build a life? How can I learn to do it just because it must be done? How can I distinguish between real and false selfishness (it feels selfish to build a life just for me)?

The business of many doctoral candidates is to find a meaning in many random, painstakingly-researched, frustrating phenomena that ties them together and gives you a new idea you can dwell on for several hundred pages. Congratulations, you’re very good at it; too good at it, as you’ve turned your talents on your own troubles.

It’s certainly possible that your fear of any and all future jobs, combined with terminal laziness, incompetence, and an inability to distinguish between real and false selfishness have paralyzed you and filled you with self-loathing. More likely, however, is that your self-doubt has written a thesis outline tying together your many layers of failure. WAIT! There is more to read… read on »

Self-confidence, like humility, is least often felt by those who deserve it most—call it the Trump theory of confidence conservation, with the baselessly-smug balancing out the needlessly self-doubting. Instead of paying attention to feelings of self-assurance, decide whether you or others have done their best, given what’s available. If so, try to act on that judgment, regardless of how you feel or how much confidence you encounter. Then you’ll do right by yourself and feel good about it, but not Donald-good, if you know what’s good for you.
–Dr. Lastname

I don’t know what to make of my wife’s efforts to find a job. When we married two years ago, she had a good job and enough money to take care of herself, but then she was put on probation—it didn’t bother her—and, since getting fired, she doesn’t seem to be trying hard to find new work. She knocks herself out to help me with errands, but then she always eats out for lunch and spends her time shopping with money she doesn’t really have. She doesn’t look worried, but I can’t get a straight story out of her about her budget or savings, and I’m beginning to worry what will happen when the money runs out. That includes my money, because I can’t afford to support the two of us indefinitely, particularly with her level of spending. I don’t want to undermine her confidence, which she obviously has lots of, or to mess up a loving relationship, but I’m afraid of what will happen if I say nothing. So what should I say?

Some people have an unshakeable confidence in themselves but shouldn’t, and for them, there is little solace. Everybody worries about people with low self-esteem, but for those with excessive self-esteem, the world is a cold place. On the other hand, they have so much faith in themselves, they don’t care.

Those with excessive self-esteem don’t necessarily suffer from too much pride or big egos, or deny some truth they don’t want to face. They just don’t see how fucked up they are because they believe they’re completely capable, and it prevents them from doing anything about their problems. WAIT! There is more to read… read on »

If you’ve ever driven in bad weather and started to lose control of your car, you know that your instincts, for better or worse, are to panic and let the wheel spin where it may or grip the wheel with white knuckles and try to overpower nature itself. Sadly, a lot of people react the same way when tragedy sets their own lives skidding off course, and no matter how much you understand their pain, you can’t stop them when they begin to slide. If that happens, however, to someone you share a life with, you may be able to straighten them out by following through on your own priorities and assuring them that your way, and your support, will help them retake their place at the wheel.
–Dr. Lastname

I know he can’t help it, but my husband has become a control freak and I can’t stand it. It started when our daughter was born with cystic fibrosis. She’s has been in an out of the hospital her whole life and the stress for us as parents is often overwhelming. My husband does an amazing job of keeping us organized and getting our daughter to her appointments—he was going to be a stay-at-home dad even before she got sick—but he’s also become overbearing and picky about everything we do, especially everything I do, which isn’t the way he was when we first married. I hate to criticize him when I know what’s driving him crazy and our first priority is sticking together, but I find I’m angry at him all the time and sad that we can never be close. Just because I’m not as obsessive as he is about our daughter doesn’t mean I don’t care. What can I do?

Let’s assume, for the moment, that you’ve gone through your best attempts to get your husband to see that he has become too controlling; you’ve tried to find him an ear, show him respect, and done everything short of shaking him really hard, all to no avail. In his campaign to control everything, he can’t control himself.

While getting physical is always a bad idea, so is trying to get persuasive. Instead, use your modest powers to draw the line and give him a hard time if he crosses it. This is the only way to find out whether he’s can learn to hold back for the sake of your marriage, or whether you need to put your marriage on hold. WAIT! There is more to read… read on »